Urinary tract infection (UTI) in men rarely occurs before 50 years of age.
Often associated with abnormal structure or function of the urinary tract (complicated UTI).
Catheter-associated UTI is the most common cause of nosocomial infection.
Imaging of the urinary tract is recommended for men with persistent haematuria, voiding dysfunction without a clearly identifiable cause such as benign prostatic hyperplasia (BPH), failure of initial therapy, or signs of upper tract infection.
Treatment with a fluoroquinolone antibiotic is generally appropriate in men as they are likely to have a UTI classified as complicated. Asymptomatic bacteriuria does not require treatment except before urological procedures.
UTI is an inflammatory reaction of the urinary tract epithelium in response to pathogenic micro-organisms, most commonly bacteria.
History and exam
Key diagnostic factors
- presence of risk factors
- suprapubic pain
- costovertebral angle pain
Other diagnostic factors
- enlarged prostate
- tender prostate
- rectal/perineal pain
- urethral discharge
- benign prostatic hypertrophy
- urinary tract stones
- urological surgery, instrumentation
- urethral strictures
- age >50
- previous UTI
- anal sex
- vaginal sex
- recent hospitalisation
1st investigations to order
- dipstick urinalysis
- urine microscopy
- urine culture
- Gram stain
Investigations to consider
- CT renal tract
- plain x-ray kidneys, ureters, and bladder (KUB)
- intravenous urogram (IVU)
asymptomatic bacteriuria before urological procedure
not severe and tolerating oral therapy
severe or not tolerating oral therapy
Timothy J. Benton, MD
Residency Program Director
Department of Family and Community Medicine
Texas Tech University Health Sciences Center
Permian Basin Campus
TJB declares that he has no competing interests.
Catherine DuBeau, MD
Professor of Medicine
Dartmouth Hitchcock Medical Center
CD is a member of the American Geriatrics Society Revision Panel for the Beers criteria for potentially inappropriate medications in older persons; planning committee, speaker, and manuscript co-author for the American Urogynecological Association State of the Science on OAB and cognition; and co-investigator, RELIEF trial (botulinum toxin for refractory overactive bladder in older women, funded by PCORI.
Richard Viken, MD
Professor of Family Medicine and Chairman of the Department of Family Medicine
University of Texas Health Sciences Center
RV declares that he has no competing interests.
Robert Pickard, MD, FRCS (Urol)
Professor of Urology
Institute of Cellular Medicine
Newcastle upon Tyne
RP declares that he has no competing interests.
- Benign prostatic hypertrophy (BPH)
- Guidelines on urological infections
- Urinary tract infection: diagnosis guide for primary care
Urinary tract infections in menMore Patient leaflets
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